Potential prevention strategies for Alzheimer disease

Primary prevention trials for Alzheimer disease (AD) should be considered because of the substantial cost of caring for AD patients. Current clues to possible treatments include the potential use of antioxidants, estrogens, anti-inflammatory drugs, drugs designed to alter apolipoprotein E4 status, and compounds altering amyloid metabolism. Because of the expense of primary prevention trials, resources should be devoted to developing epidemiological clues for environmental loss in vivo and searching for additional epidemiological clues for environmental factors that may protect individuals from AD. A primary prevention trial would involve the recruitment of 4,000-5,000 subjects followed for 3-5 years at a cost of approximately $20 million. Alternatively, a primary prevention trial could be performed as an "add on" study to an existing clinical trial of a compound of interest currently being tested in an elderly population at substantially less cost.